Recoveries and expenditures from fraud cases under Medicaid 2023

Approximately 1.2 billion U.S. dollars was recovered by the Medicaid Fraud Control Units (MFCUs) in 2023, roughly 71 percent of which came through criminal recoveries. The remaining 29 percent was recovered through civil convictions. With the unit's expenditure at 369 million U.S. dollars, this resulted in the MFCU recovering 3.35 dollars for every one dollar spent.

Civil recoveries surpass one billion U.S. dollars

Medicaid fraud is a widespread problem in the United States, and the role of the MFCUs is vitally important in combatting the exploitation of the program – criminal cases opened by MFCUs led to around 1,143 convictions in 2023. Criminal recoveries totaled 272 million U.S. dollars in 2023 – much lower than the previous year. While civil recoveries increased by nearly half a billion U.S. dollars between 2022 and 2023.

Types of fraud and abuse cases

MFCUs investigate fraud and patient abuse or neglect in nursing homes and care facilities. If there is a legitimate claim, MFCUs may file a criminal prosecution, a civil file, or even both. Fraud cases involve wrongdoings such as tax evasion, false claims, or billing for services that were never provided. Examples of patient abuse or neglect include a provider failing to supply the most basic of care or finding evidence of inadequate patient supervision. The continued success of the MFCUs can act as a major deterrent in the fight against Medicaid fraud and abuse.